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Dermatology Associates
1810 6th Street
Berkeley, California 94710
Tel: 510-848-2060
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This service should not be used in place of a visit, call, consultation with or the advice of your healthcare provider.

Communicate promptly with your provider with any health related questions or concerns.

 

Actinic Keratoses

Actinic keratoses (AKs) are dry, scaly patches that form on sun exposed areas of the skin, including the scalp, face, forearms, and back of the hands.

Actinic keratoses are usually scaly, feel like sandpaper to the touch, and range in color from skin-toned to reddish-brown. Actinic keratoses may be as small as the head of a pin or as large as a quarter (or bigger, if left untreated).

Most people with one actinic keratosis (AK) lesion will develop others. Actinic keratoses can appear in groups and many may be undecteded. They may occassionally itch or become tender, especially after sun exposure.

When actinic keratoses occur on the lip, they are referred to as actinic cheilitis. This type of AK appears as cracking, dried lips, often around the border of the lip.

Actinic keratoses are most common in individuals over 40 years old with fair skin and years of excessive sun exposure. However, even younger people (including those with dark skin) can develop actinic keratoses if they live in very sunny climates.

Are Actinic Keratoses Dangerous?

Actinic keratoses are considered precancerous and have the potential to become a type of skin cancer called squamous cell carcinoma (SCC). Therefore, your doctor will be diligent in diagnosing, treating, and monitoring actinic keratoses. Also, since actinic keratoses result from chronic sun exposure, you are at risk for other types of skin cancer.

Fortunately, actinic keratoses are treatable when detected in the early stages. People at risk for actinic keratoses and skin cancer can reduce that risk by performing frequent skin self-exams and seeing their doctor for regular screenings.

What Are the Treatment Options for Actinic Keratoses?

There are many treatment options for actinic keratoses.After diagnosing your actinic keratoses, your doctor will consider these factors:

  • The number, size, and location of actinic keratoses lesion(s)
  • Results of past treatments, if treated before
  • Your age and medical history, such immune system function
  • Your personal preferences

Actinic keratoses before treatment          Actinic keratoses after treatment

            Before                                After

Before choosing a treatment, your doctor may recommend a skin biopsy to be sure that your  isn’t cancerous. This is done by removing all or part of the actinic keratoses and examining the tissue under a microscope.

Medications for Actinic Keratoses

There are several safe and effective medications for the treatment of actinic keratoses:

  • Aldara® (imiquimod) Cream, 5%
  • Carac® , or Efudex® (5-FU)
  • Solaraze® (diclofenac)
  • Zyclara™ (imiquimod) Cream, 3.75%

These medications are generally prescribed for several weeks or months.

Your personal treatment regimen may vary depending on the medication prescribed, the area to which it is applied, the number of lesions being treated, and your ability to tolerate any irritation or other side effects. This makes it important to closely follow your doctors’s specific instructions.

Procedures for Actinic keratoses

Several dermatologic procedures are effective for the treatment of actinic keratoses. Your doctor will recommend a procedure that is best suited to the location of the actinic keratoses and other variables. These procedures may be combined with other procedures or medications.

Cryosurgery uses liquid nitrogen to freeze off the lesions. It is fast, has a high cure rate, and is well-tolerated by most people. There may be a very brief period of stinging when the liquid nitrogen is first applied, but anesthesia is not required.

Shave removal is a procedure during which a scalpel is used to remove the lesion and obtain a specimen for testing.

Curettage is often used to remove hard, thickened actinic keratoses. In this procedure, a small, round, sharp instrument (called a curette) is used to scrape the actinic keratosis, either removing a piece of it for biopsy or removing the entire lesion.

Lasers deliver an intense light focused on the lesion, removing it along with the top layer of skin. The finely controlled nature of laser removal makes this a useful option for actinic keratoses on delicate skin, such as the lips (actinic chelitis), or in narrow, hard-to-reach places (such as behind the ears).

Additional treatment options include chemical peels and photodynamic therapy (PDT).

Key points about treatment

  • Be patient. Some treatments take longer than others, and some actinic keratoses may require more than one treatment.
  • During treatment, actinic keratoses may look worse before they look better. Some medications will make actinic keratoses appear that weren’t previously visible.
  • Be aware that your insurance company may require a higher co-payment for some medications or procedures. These higher costs may be offset by shorter healing time or other desired outcomes.

Whether your treatment is an in-office procedure that takes just an hour or a topical regimen that lasts several weeks, your doctor will monitor your skin’s condition to make sure the treatment is working and that side effects are manageable. 

Talk to your doctor if you are concerned about any side effects that you experience.

Tips for People with Actinic keratoses

Avoid the sun
The best way to avoid new actinic keratoses and skin cancer is to protect your skin from the sun. If you can’t avoid spending time outdoors, make sun protection a priority. Use a broad-spectrum sunscreen with a minimum SPF of 30, and cover your skin with long-sleeved shirts, pants, and a wide-brimmed hat. 

Perform skin self-exams
As someone who has already been diagnosed with actinic keratoses, you are likely to develop more actinic keratoses over time—it’s vitally important, therefore, to perform regular skin self-exams. The goal is not only to detect new actinic keratoses but also to check for changes in existing lesions, such as bleeding or a change in size.

Where can I learn more?

Images courtesy of Gerald Goldberg, M.D.

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© 2010 Vivacare. 
Last updated April 6, 2010.

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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Aldara Cream is a skin-use only (topical) prescription medicine used to treat certain types of actinic keratosis on the face and scalp of adults with normal immune systems.

Safety Information:

When using Aldara Cream, the most common side effects involve skin reactions in the application area. These include redness, swelling, a sore, blisters, or ulcers, skin that becomes hard or thickened, skin peeling, scabbing and crusting, itching, burning, and changes in skin color that do not always go away.

When using Aldara Cream for actinic keratosis exposure to sunlight (including sunlamps) should be avoided or minimized during use of Aldara Cream because of concern of heightened sunburn susceptibility. Patients should be warned to use protective clothing (hat) when using Aldara Cream.

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